Metastatic prostate cancer: understanding a terrifying diagnosis

If you or a family member have been diagnosed with metastatic prostate cancer, you’re probably feeling a lot of emotions right now. It’s normal to feel confused, scared, and overwhelmed when you or a loved one are facing a serious illness. 

One thing that may help ease some of these fears is information—knowing more about this condition and your options for treating it. 

While it won’t completely take away your concerns, understanding metastatic prostate cancer can help you feel more in control of your situation and empower you to talk about your illness with your healthcare providers.

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Prostate cancer is the most common cancer diagnosed in males worldwide. In 2018, about 1.2 million new cases were discovered. Fortunately, most prostate cancers are slow-growing, so healthcare providers often have enough time to treat them (Leslie, 2021).

The prostate is a walnut-sized gland located around the urethra at the base of the penis. Its job is to produce about one-third of the fluid present in semen. This fluid nourishes the sperm and maintains a high pH that helps sperm survive (Leslie, 2021).

Prostate cancer begins with a mutation in the cells of the prostate gland that causes them to grow abnormally. The cancer cells start to spread into the surrounding prostate tissue, forming a tumor. This tumor can stay within the prostate, or it can begin to spread to other organs outside the prostate (Leslie, 2021).

If prostate cancer cells spread to other areas of the body, this type of cancer is called metastatic prostate cancer. The most common areas that prostate cancer spreads to are the bones and the lymph nodes (Leslie, 2021).

Often, men with prostate cancer don’t experience any symptoms associated with prostate cancer at first. When it does cause early symptoms, they can be easy to mistake for other health conditions such as benign prostatic hyperplasia or BPH (a condition common in aging men). These symptoms can include (Leslie, 2021; Mullangi, 2021):

• Having to urinate frequently

• Pain when urinating

• Trouble emptying your bladder fully

• Blood in your urine

• Chronic back pain

Your provider might notice that your prostate is enlarged when they perform a digital rectal exam. An enlarged prostate is usually a benign condition that doesn’t generally point to cancer, but your provider should try to find what is causing it (Mullangi, 2021).

Later symptoms of prostate cancer can include (Leslie, 2021):

• Fatigue

• Trouble getting an erection

• Painful ejaculation

• Pain in other parts of the body

Metastatic disease most commonly spreads to the low back, pelvis, hips, or ribs. When it does, it can cause bone pain, tingling, weakness, or trouble with your bladder and bowels (Leslie, 2021).

The most important risk factor for prostate cancer is your age. It is very rare to be diagnosed with prostate cancer before the age of 40 (Mullangi, 2021). 

Prostate cancer also tends to run in the family. You have a higher risk of getting prostate cancer if you have close male relatives who also have prostate cancer. No single gene is responsible for prostate cancer, but several have been implicated. This includes mutations in BRCA1 and BRCA2, the genes best-known for being associated with breast cancer (Mullangi, 2021; Leslie, 2021).

Other factors that can increase your risk for developing prostate cancer include (Mullangi, 2021; Leslie, 2021):

• Smoking cigarettes

• Obesity

• High testosterone levels (for example, from using steroids to build muscle)

• Exposure to toxic chemicals (such as Agent Orange)

• Diets high in saturated fats and milk products

• Low vitamin D levels

• Having African American ancestry

• Many lifetime sexual partners

• A history of sexually transmitted infections

Cancer researchers used to think that having a vasectomy could increase your risk of getting prostate cancer. However, follow-up studies couldn’t confirm that there was any connection (Leslie, 2021).

Since the two most significant factors for getting prostate cancer are age and genetics, you can’t really prevent it. The best way to lower your risk for all health conditions is to live a healthy lifestyle. You can also talk to your healthcare provider about what screening tests are appropriate for you.

Your healthcare provider might screen you for prostate cancer if you have any symptoms. Even if you aren’t having symptoms, they may screen you if you have a lot of risk factors. This screening is usually done through a urine test that checks your levels of an enzyme called prostate-specific antigen (PSA test) that can be elevated with prostate cancer. In 2012, the United States Preventative Services Task Force (USPSTF) recommended against routine PSA screening if a person doesn’t have any risk factors. Instead, they recommend that healthcare providers and patients decide together whether PSA screening is suitable for each person. 

If you have an elevated PSA level, your healthcare provider can discuss possible next steps with you. These might include active monitoring or a prostate biopsy (Mullangi, 2021; Leslie, 2021).

If prostate cancer is found in your biopsy, you’ll be given a Gleason score. Initially developed by a pathologist named Dr. Gleason in the 1960s, this scoring system helps healthcare providers tell how advanced your cancer might be and what treatments are more likely to be needed (Leslie, 2021).

Your provider might also order imaging scans of your chest, abdomen, or pelvis to check for any places that your cancer might have spread to (these are called metastases). These could be computed tomography (CT scans) or magnetic resonance imaging (MRI scans) (Mullangi, 2021).

You will likely be assigned a team of healthcare providers to treat you during your illness. These can include specialists from medical oncology, radiation therapy, surgery, or palliative care.

The options for prostate cancer treatment change depending on whether your cancer has spread beyond your prostate gland or not. For metastatic prostate cancer, the choices usually include hormone therapy, radiation therapy, immunotherapy, chemotherapy, or participating in a clinical trial for new treatments. Specific types of surgery may be considered to relieve certain symptoms associated with metastases, but the mainstays of treatment for metastatic prostate cancer are those listed below (Leslie, 2021).

Hormone therapy

Your prostate gland requires androgens (testosterone) to function optimally. Blocking androgen receptors in your body through androgen deprivation therapy (ADT) causes your prostate to shrink along with any prostate cancer. Several different antiandrogen medications can be used to accomplish this, such as enzalutamide. Hormone therapy to treat prostate cancer has been used for over 70 years (first as surgical removal of the testicles, a procedure that is no longer commonly performed) and is very successful at causing this type of cancer to go into remission (Anassi, 2011; Komura, 2018).

Chemotherapy

If hormone therapy to block androgens isn’t successful, your provider can try other medications. Some of the medicines most commonly used to treat metastatic prostate cancer alone or in combination include (Teo, 2019):

• Corticosteroids

• Docetaxel

• Mitoxantrone

• Estramustine

• Abiraterone acetate 

There has been tremendous progress made with chemotherapy for prostate cancer in the last decade. The U.S. Food and Drug Administration (FDA) has approved six new medications for prostate cancer, and more are in development (Teo, 2019).

Immunotherapy

Immunotherapy is a type of cancer treatment that helps your immune system fight the cancer cells in your body. One type of immunotherapy used for men with metastatic prostate cancer is called Sipuleucel-T. It’s made from your own blood cells. Researchers aren’t exactly sure how it works, but Sipuleucel-T can help increase the amount of time you can live with prostate cancer.  (Leslie, 2021; Anassi, 2011).

Bisphosphonate therapy

Bisphosphonates, such as denosumab, are a class of medication used to treat bone loss and prevent bone fractures resulting from metastatic prostate cancer. While they won’t directly affect your cancer, they can help improve your quality of life. If you are prescribed these, they are typically taken with supplemental oral calcium and vitamin D to have the most effect (Leslie, 2021).

Radiation therapy

The current types of radiation therapy used for prostate cancer can focus a beam of energy on just the area of the tumor. These are called three-dimensional conformal radiation therapy and intensity-modulated radiation therapy. They can reduce the toxic side effects of radiation on the healthy tissues around the tumor, improving your long-term outcome and helping treat painful bone metastases (Brawley, 2018).

Clinical trials

Over the last few decades, researchers have made considerable progress in treating prostate cancer. Some of these discoveries include (Teo, 2019):

• New tests to look at the genetic markers of prostate cancer

• New imaging techniques to detect the spread of cancer earlier

• New drugs that target different genetic pathways involved with cancer

Clinical trials are ongoing to test these new treatments and new ways of combining the treatments we already have (Teo, 2019). 

A cancer diagnosis can be terrifying no matter what type or stage it is. Fortunately, there are treatments available even if you have advanced prostate cancer. 

The exact prognosis for metastatic prostate cancer is unique to each individual. Your healthcare provider can give you more detail depending on (Mullangi, 2021; Leslie, 2021):

• Your age

• Your health before your diagnosis

• The characteristics of your tumor’s tissue

• Where in your body the cancer has spread

• How well you tolerate cancer treatments

Even if your healthcare provider doesn’t feel that your cancer can be cured, there are still treatments you can try. Chemotherapy, immunotherapy, and radiation can all be used as palliative treatments for metastatic prostate cancer. This means that they can be used to help you live longer and manage your symptoms, even if they can’t make your cancer go away (Mullangi, 2021).

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

November 10, 2021

Written by

Ellyn Vohnoutka, BSN, RN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.